Suicide Prevention and the Role of the Social Determinants of Health

1. Suicide Prevention and the Role of the Social Determinants of Health June 25, 2009 www.promoteacceptance.samhsa.gov

2. Contact Us SAMHSA ADS Center11420 Rockville PikeRockville, MD 20852 Toll free: 1-800-540-0320Fax: 240-747-5470Web: www.promoteacceptance.samhsa.govE-mail: promoteacceptance@samhsa.hhs.gov The Moderator for this call is Michelle Hicks. www.promoteacceptance.samhsa.gov

3. Disclaimer The views expressed in this training event do not necessarily represent the views, policies, and positions of the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, or the U.S. Department of Health and Human Services. www.promoteacceptance.samhsa.gov

4. Questions? At the end of the speaker presentations, you will be able to ask questions. You may submit your question by pressing ‘*1’ on your telephone keypad. You will enter a queue and be allowed to ask your question in the order in which it was received. On hearing the conference operator announce your name, you may proceed with your question. www.promoteacceptance.samhsa.gov

5. Speakers Anara Guard, Deputy Director, Suicide Prevention Resource Center Anara Guard, MLS, is Deputy Director for the National Suicide Prevention Resource Center, which is funded by the Substance Abuse and Mental Health Services Administration. In this capacity, she manages resource center functions, provides communications assistance to SAMHSA-funded youth suicide prevention grantees, and oversees all grantee technical assistance. She previously was Director of Information and Marketing for Join Together, a project of the Boston University School of Public Health that promotes substance use disorders prevention and treatment through community strategies. Prior to that, she worked at Education Development Center for 7 years, primarily with the Children’s Safety Network Injury and Violence Prevention Resource Center. She serves on the board of the Massachusetts and Rhode Island Regional Poison Control Center and edits a regular column for the international journal, Injury Prevention. She has a master’s degree in library and information science and a certificate in maternal and child health. www.promoteacceptance.samhsa.gov

6. Speakers Heidi Bryan, Founder and Director, Feeling Blue Suicide Prevention Council Heidi Bryan is the founder of Feeling Blue Suicide Prevention Council, a suicide prevention, education, and support nonprofit organization for Pennsylvania.  Heidi has battled with depression most of her life, is a suicide attempt survivor, and lost her brother to suicide in 1995.  Heidi was the Vice-Chairman of the Board of Directors for SPAN USA and recipient of the Sandy Martin Grassroots Award in 2005.  Ms. Bryan is a certified QPR gatekeeper and Master trainer, a provisional ASIST trainer, co-facilitator of a survivor of suicide support group, and co-chairman of Pennsylvania's Adult and Older Adult Suicide Prevention Coalition.   She recently developed the booklet, After an Attempt: The Emotional Impact of a Suicide Attempt on Families, which was distributed to all the hospitals in Pennsylvania. Ms Bryan was also recently chosen to serve on the National Suicide Prevention Lifeline’s Consumer/Survivor Committee and is a board member for the American Foundation for Suicide Prevention. Through Heidi's efforts, Pennsylvania adopted a Suicide Prevention Week Resolution that coincides with the National Suicide Prevention Week. Ms. Bryan received her Bachelor’s degree in Chemistry from Cedar Crest College. www.promoteacceptance.samhsa.gov

7. Speakers Diana Morales, Vice President, Public Education, Mental Health America Diana Morales joined the Mental Health America in May 2006, as vice president of public education. Diana has nearly two decades of experience in developing and managing health promotion programs. At Mental Health America, Diana is responsible for the strategic direction and oversight of the organization’s national efforts to promote mental wellness. Key MHA educational programs that she oversees include Live Your Life Well from the Campaign for America’s Mental Health, featuringproven tools for protecting mental health and improving well-being; Dialogue for Recovery, designed to enhance recovery and quality-of-life for people with mental illnesses; FundaMENTAL Health, Bottomline Sense, aimed at addressing the impact of mental health conditions on the U.S. workforce; and mpower: musicians for mental health, meant to engage youth about mental health and reduce stigma. Prior to Mental Health America, Diana was senior vice president in the healthcare practice of Manning Selvage and Lee, New York, a leading global public relations firm. Diana earned a master’s in public health from the Johns Hopkins Bloomberg School of Public Health. She received a bachelor’s of science degree in journalism with a minor in government and politics from the University of Maryland, College Park. www.promoteacceptance.samhsa.gov

8. Suicide Prevention and the Role of Social Determinants of Health Anara Guard Deputy Director Suicide Prevention Resource Center June 25, 2009

9. The economic crisis… • Layoffs and unemployment • Foreclosures and evictions • Business closings • Personal and business bankruptcies • Loss of retirement savings, investments

10. What people want to know is… • Is the economic downturn causing suicide? Is this an economic “disaster” that will affect people like other massive natural disasters? • And, if so, what can we do about it? How can we place “buffers” in systems, to help identify people in distress, refer them appropriately, increase resiliency?

11. Research and studies show • Unemployment and economic downturns ARE associated with increased rates of suicide and/or suicide attempts (Kraut; Lewis; Koo; Stack 1984; Stack 2000) BUT … • Many individuals with other risk factors for suicide also tend to be unemployed • Existing mental illness confounds the results (Blakely; Hafner) • Unemployment is bad for your overall health (Brenner; Gerdtham; Strully)

12. Research and studies show • Heavy binge drinking (Andreeva) and other substance use (Hafner) confound the results • Studies in societies with other support systems show differing results (In the U.S., illness or medical bills contributed to 62.1% of all bankruptcies in 2007.) (Himmelstein) • Male rates increase more than females (Stack; Loo; Berk; Inoue); men are already at higher risk of suicide

13. Research and studies show • Loss of employment does not CAUSE suicide but is associated with depression, substance abuse problems and marital turmoil • All of which are independently linked to suicide risk…Association is not causation

14. The economic crisis… • We can expect a sharp downturn in the economy to increase suicide risk, especially among working-age men, and older adults whose retirement security is threatened. • Prevention is important!

15. Warning signs—Tier one GET IMMEDIATE HELP if someone is: • Talking of hurting or killing oneself • Looking for ways to kill oneself • Talking or writing about death or suicide when these actions are out of the ordinary

16. Warning signs—Tier two Contact a professional or call a crisis line IF someone shows: • Hopelessness • Rage, uncontrolled anger, seeking revenge • Acting reckless or engaging in risky activities • Feeling trapped - like there's no way out • Increased alcohol or drug use • Withdrawing from friends, family, and society • Anxiety, agitation, unable to sleep or sleeping all the time • Dramatic mood changes • No reason for living, no sense of purpose in life

17. Risk and Protective Factors at the Individual Level Risk • Age/Sex • Mental illness • Substance abuse • Loss • Previous suicide attempt • Personality traits or disorders • Incarceration • Access to means (e.g., firearms) • Failure/academic problems • Unemployment • Disability or illness • Protective • Cultural and religious beliefs that discourage suicide and support self-preservation • Support through ongoing health and mental health care relationships • Coping/problem solving skills • Resiliency, self esteem, direction, perseverance, optimism, empathy • Intellectual competence (youth) • Reasons for living

18. At Peer and Family Levels Risk • History of interpersonal violence/conflict/abuse/bullying • Exposure to suicide • No-longer married • Barriers to health care/mental health care • Accessto means (e.g., firearms) • Protective • Family cohesion (youth) • Sense of social support • Interconnectedness • Married/parent • Access to comprehensive health care

19. AtCommunity Levels • Protective • Access to healthcare and mental health care • Social support, close relationships, caring adults • Respect for help-seeking behavior • Skills to recognize and respond to signs of risk Risk • Isolation/social withdrawal • Barriers to health care and mental health care • Stigma • Exposure to suicide • Unemployment

20. AtSocietal levels Risk • Western areas • Rural/Remote • Cultural values and attitudes • Media influence • Alcohol misuse and abuse • Social disintegration • Economic instability • Protective • Urban/Suburban areas • Access to health care & mental health care • Cultural values affirming life • Media influence

21. What we can do… • Temper sensational bad news. • Encourage more support and more accessible services. • Help those affected cope effectively. • Address acute and chronic stress and distress. • Promote the warning signs and appropriate responses.

22. WHAT TO DO • Always include a referral phone number and information about local crisis intervention services

23. Preventability • 90% of attempters do not go on to die by suicide. • Most suicides are impulsive (particularly youth), often occurring the same day. • Convenient means makes impulsive actions easier. • Restricting lethal means makes a real difference (bridge barriers, firearms).

24. What you can do… • Help those affected cope effectively. ASK. Reach out. • Address acute and chronic stress and distress. • Watch out for precipitating events and respond with empathy, help, connection. • Refer to SPRC’s talking points on the Relationship between the Economy, Unemployment and Suicide, 2009. www.sprc.org/library/Economy_Unemployment_and_Suicide_2008.pdf

25. Resources • Warning signs http://www.sprc.org/featured_resources/bpr/PDF/AASWarningSigns_factsheet.pdf • At-a-Glance: Safe reporting on suicide http://www.sprc.org/library/at_a_glance.pdf • National Association of School Psychologists Economic Crisis resources (for students, parents, staff) http://www.nasponline.org/educators/economic.aspx

26. More resources • A webinar focusing on the economic downturn and suicide risk can be found on the SPRC website at Training Institute/ Research to Practice Webinars: www.sprc.org/traininginstitute/disc_series/disc_16.asp • Contact the Suicide Prevention Resource Center Phone: 877-GET-SPRC (438-7772) Web: www.sprc.org Email: info@sprc.org

27. Is the crisis “causing” suicide? • Take suicidality seriously, but keep in mind: in the midst of fund losses, foreclosures, bankruptcies and layoffs, most people are NOT suicidal, are NOT attempting suicide, are NOT dying by suicide.

28. Suicide Prevention and the Role of the Social Determinants of Health June 25, 2009 Heidi Bryan Feeling Blue Suicide Prevention Council

29. Personal Story • Learning from the past • Family experiences • Receiving appropriate services • Connecting with people • Learning to ask for help

30. Social Determinants • Stressors: Possible Triggers • Employment – Job Loss • Family – Marital/Relationship Problems • Substance Use • Change in socioeconomic status • Environmental factors (neighborhood, city, State) • What can you do? • Ask or seek help

31. Feeling Blue Suicide Prevention Council • Outreach program of St. Martin’s Episcopal Church • 2003 joined New Beginnings Non-Profit Incubator Program • 2004 full-time • July 2007 “graduated” from New Beginnings

32. Mission Statement Feeling Blue Suicide Prevention Council is a community organization dedicated to preventing suicide, reducing the stigma associated with suicide, and supporting those people affected by depression or the loss of a loved one to suicide. We do this through education and support.

33. Services Offered • Resource Manuals/Information/Posters • Presentations • After an Attempt: The Emotional Impact of a Suicide Attempt on Families • Website – www.feelingblue.org • Survivor Support • Suicide Anonymous

34. Services Offered • ASIST Suicide Prevention Training • QPR Gatekeeper Suicide Prevention Training ~ 1,750 people trained • Suicide Prevention Program Trainings • Lifelines High School Suicide Prevention Program

35. Services Offered • “On the Scene” Presentations • Funeral directors, clergy, law enforcement • After a Suicide School Guidelines • Videos

37. The Charge • Create a national, multi-year effort through Campaign for America’s Mental Health that employs a wellness frame to educate the public that mental health is fundamental to overall health and well-being

38. A Major Need U.S. Population 18 Years and Older (Gallup-Healthways Well-Being Index)

39. Live Your Life WellSM Campaign Goal • Increase the percentage of people who begin taking one or more of 10 evidence-based actions to protect their mental health on a regular basis

40. Live Your Life WellSM Campaign Objectives • Increase awareness that: • mental health is integral to overall health and well-being • there are evidence-based ways to preserve and strengthen your mental health • Increase the percentage of people who believe that they can take actions to maintain and protect their mental health

41. Supporting Research • Major journals like American Journal of Epidemiology, Journal of Personality and Social Psychology and Proceedings of the National Academy of Sciences • Materials from Harvard Medical School report on stress, NIH, CDC, and Mayo Clinic • Material reviewed by leading experts • Sleep: Neurology professor at George Washington University Medical Center • Help Others: Director of Center for Medical Humanities at Stonybrook University • Spirituality: Epidemiologist at Duke University Medical Center

42. Research suggests that social connection: Fights stress Promotes health May even lengthen one’s life Tips for connection Create new ties Strengthen existing relationships Support groups Live Your Life WellSM Tool 1: Connect with Others

43. Research suggests that: Thinking negatively can affect mood, actions and health Ways to stay positive Foster optimism Practice gratitude Avoid dwelling on worries and self-criticism Live Your Life WellSM Tool 2: Stay Positive

44. Research suggests that exercise helps: Prevent heart disease, immune system problems and more Ease some kinds of pain Improve mood Tips for exercise Guidelines and recommendations Ways to get more Overcoming obstacles Live Your Life WellSM Tool 3: Get Physically Active

45. Research indicates that those who help: Experience less depression Have greater calm Enjoy better health Tips for helping Steps can be small Vary how you help Finding the right fit for volunteering Live Your Life WellSM Tool 4: Help Others

46. Research shows poor sleep linked to: Greater risk of depression and anxiety Increased risk of heart disease and stroke Greater likelihood of accidents Tips for improving sleep Regular bedtime, watch caffeine and more Sleep medications Get help for insomnia Live Your Life WellSM Tool 5: Get Enough Sleep

47. Research suggests that positive feelings can: Support resiliency Boost ability to solve problems Help fight disease Tips for creating joy and satisfaction Suggestions for humor and leisure Role of music, arts, nature Finding “flow” activities Massage and other relaxation techniques Live Your Life WellSM Tool 6: Create Joy and Satisfaction

48. Research indicates that the right foods can: Boost energy Lower the risk of developing certain diseases Provide fuel to your brain Counteract the impact of stress on one’s body Ingredients for a healthy diet USDA recommendations Don’t skip meals, limit alcohol and other tips Possible links between diet and mood Live Your Life WellSM Tool 7: Eat Well

49. Research suggests that: Religious belief, practice and attending services combat stress and may help fight disease Meditation alters brain functioning Ways to foster one’s spirituality Read spiritual texts Practice one of provided meditation techniques Connect with one’s deepest self through journaling, nature or exploring key values Live Your Life WellSM Tool 8: Take Care of Your Spirit

50. Research studies found that: People who problem-solved in a stressful situation felt less depressed People who focused on the positives in their lives suffered less from painful memories Ways to deal better in difficult times Write for emotional release List and assess solutions Get support Live Your Life WellSM Tool 9: Deal Better with Hard Times